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Laser Surgery

The diode-pumped Nd:YAG laser Limax速 satisfies the highest demands for treatment quality and operating convenience


“Metastatic resection with the Limax® laser enables the gentle removal of multiple metastases while preserving the healthy tissue to the greatest possible extent. Even patients that previously had to be classified as inoperable can be excellently treated with this new laser technique. What’s more, patients also benefit from a significant increase in their quality of life after the operation. With its very high output power of 120 W, the Limax® laser from KLS Martin saves me a lot of time as it speeds up the whole process significantly, compared with previous types of laser. Moreover, my surgical team loves to work with the Limax® as well, due to its intuitive handling and the full integration of peripheral devices such as a smoke evacuator and a gas irrigation unit.”

Prof. Dr. Bernward Passlick (MD) Medical Director, Department of Thoracic Surgery University of Freiburg im Breisgau, Germany

“The use of KLS Martin Limax® lasers represents an important step forward in the resection of pulmonary metastases. As healthy tissue can be preserved to a great extent, the patient’s post-operative quality of life is enhanced significantly. Moreover, the tissue-preserving resection of metastases with the Limax® laser ensures that patients can be reoperated in case of need. From an economic point of view, using the laser method makes a lot of sense, too, as the tissue-preserving resection of metastases with the Limax® laser allows the treatment of patients who previously had to be classified as inoperable. Besides, the laser simply eliminates high costs for consumables such as staplers.”

University lecturer Dr. Thomas Graeter, M.D. Chief Physician of the Clinic for Thoracic and Vascular Surgery, Loewenstein, Germany


L i m a x ®: t h e t e c h n o l o g y o f t h e f u t u r e

The diode-pumped Nd:YAG laser Limax® satisfies the highest demands for treatment quality and operating convenience

With the launch of the new diode-pumped Nd:YAG laser Limax®, surgeons have a laser system at their disposal which offers a triple advantage, combining the excellent beam quality of solid state lasers with an extremely high output power for faster interventions and a wavelength specially optimized for use on parenchymal tissue. The use of lasers with a wavelength of 1,318 nm has gained more and more ground in recent years, especially for the resection of multiple metastases. The optimal coefficients of absorption in both water and hemoglobin – exclusively attainable with the 1,318-nm wavelength – are just perfectly suited for cutting, coagulating and sealing parenchymal tissue. Apart from its clinical advantages, this new laser is a great economic solution as well. It not only saves you a lot of money on consumables, but also boosts the number of patients eligible for laser therapy.

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L i m a x ®: c o s t - e f f i c i e n t a n d r e l i a b l e

Reliable resecting, coagulating and sealing while preserving healthy tissue to the greatest possible extent

The wavelength of 1,318 nm enables precise resection in parenchymal tissue. Thanks to its optimal ratio of absorption in water and hemoglobin, this wavelength lets you achieve excellent sealing results. In other words, precise lesion resection with maximum preservation of healthy tissue.

Bronchoscopy is another field where selecting the right wavelength is of primary importance. Due to their low absorption in hemoglobin, wavelengths above 1,318 nm cannot produce the intended coagulation effect, but primarily lead to tissue desiccation instead. The 1,318-nm wavelength is different because of its first-rate absorption in hemoglobin. It therefore prevents unwanted side effects such as dreaded edemas. Besides, the pulsed operating mode allows it to be used for gentle, tissue-preserving endobronchial applications as well.

The surgical advantages of the Limax® system ■ ■

■ ■

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Greatest possible preservation of healthy tissue Maximum precision – even the most difficult localizations can be treated Flexible, yet mechanically strong coagulation zones allow for visceral pleura sutures for increased safety Dry (hemorrhage-free) and fistula-tight resection surfaces Intervention can be repeated in case of recidivation Significantly increased life expectancy with almost no loss in the quality of life


Limax® – the surgical laser and its fields of use

Application examples for open thoracic surgery: ■ ■ ■ ■ ■ ■

Metastatic surgery Parenchymal bridge transection Pulmonary vesicle resection Open pulmonary biopsies Removal of benign tumors Bronchial carcinoma operations

Application examples for thoracoscopic surgery (VATS): ■

■ ■ ■

Surgical techniques available: Enucleation, wedge resection, lobectomy, typical and atypical segmental resections, bisegmentectomy (plus a combination of any of these procedures)

■ ■ ■

Pulmonary vesicle ablation and thermal pleurectomies in cases of spontaneous pneumothorax Air vesicle ablation in pulmonary emphysema cases General hemostasis and fistula sealing Removal and enucleation of pleuropulmonary coin lesions (malignant and benign tumors) Partial resection of lung tissue Recurring pneumothorax Adhesiolysis Pleurodesis (various causes)

Application examples for visceral surgery: Application examples for endobronchial surgery:

■ ■ ■

■ ■ ■ ■

Tumor ablation Removal of stenoses Vaporization of pathologic tissue Hemostasis

Metastatic surgery on liver, kidneys and spleen Benign tumor surgery Open biopsy on liver, kidneys and spleen Carcinoma resection on liver, kidneys and spleen

Application examples for phlebology: ■ ■ ■

Endovenous laser occlusion of saphenous veins Endovenous laser occlusion of perforating veins Endovenous laser occlusion of lateral saphenous branches

Economic advantages ■ ■

■ ■

Savings in expensive consumables (e.g. stapler magazines, fibrin glues) Extended interdisciplinary indications in open thoracic surgery, thoracoscopy, endobronchial surgery, visceral surgery and phlebology, therefore more patients can be treated The KLS Martin laser Limax® enables the inclusion of patients that were previously considered “inoperable” Enhanced hospital reputation due to use of innovative laser technology and advanced methods Optimal utilization by ambulatory use of the laser in phlebology

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L i m a x ®: a s t e p a h e a d i n l a s e r s u r g e r y

Optimal wavelength – superior beam quality, intuitive handling

The diode-pumped Nd:YAG laser Limax® represents a significant step forward in parenchymal laser surgery.

0,001 0.001

Er:YAG 2,92 2.92 μm 10 5

0,1 0.1 1

1,318 1.318 μm

Nd YAG 0,01 0.01 1,064 1.064 μm

Extinction length (mm)

Due to its specific wavelength of 1,318 nm and the high coefficients of absorption in water and hemoglobin associated with it, the Limax® is perfectly suited for combining resection, coagulation and tissue sealing effects for optimal control of the two greatest problems when working on lung parenchyma – hemorrhages and air loss.

pp

π

10 4 10,6 10.6 μm

p

Optimal wavelength

2.1 μm 2,1 Ho 10 2

10

Co 2

10 1 100

1

2

3

4

5

6

7

8

10

12

λ

(μm)

BAYLY ET AL.

Best beam quality In contrast to direct-diode lasers, the diode-pumped Nd:YAG laser Limax® emits laser radiation of constant quality, irrespective of the set power. Whereas the beam diameter of direct-diode systems increases with increasing power and beam precision decreases strongly as a result, the Limax® system enables the surgeon to work at a constant beam quality with a power of up to 120 W. This allows for fast operations with maximum power densities of > 100 kW/cm2 and fibers with very small diameters of 260 µm.

Intuitive operation In addition to the laser, the Limax® system integrates a dedicated smoke evacuator and gas irrigation unit into a single, compact platform. Besides, all the parameters for these components can be easily controlled via the intuitive Limax® software and stored according to the user’s preferences.

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260 µm

400 µm

600 µm

Limax®

Direct diode lasers 260 µm

400 µm

600 µm


The technical advantages at a glance ■ ■ ■ ■ ■ ■

Optimal wavelength Integrated smoke evacuator Intuitive handling User-customizable standard programs No heavy-current connections required Low-sound generation

Ordering Data 120 diode-pumped Nd:YAG laser Limax®

■ ■ ■ ■ ■ ■

Best beam quality Integrated gas irrigation Highest power densities Very comprehensive set of accessories Service-friendly design Extremely low-maintenance

Item Number 79-050-00-04

We’ll be glad to inform you about our comprehensive range of accessories.

Technical Data Limax® 120 Laser type Laser wavelength Laser output power Pulse type

Pilot laser wavelength Pilot laser power Beam delivery Laser beam quality Light guide connector Control and monitoring Operation Cooling Mains power supply, version E (U) Mains current Mains fuses Power input Laser class Protection class Type of protection Classification acc. to MPG/MDD Pilot laser Noise level Smoke evacuator (VAC) VAC control VAC mains power supply VAC mains current VAC mains fuses VAC power input Dimensions (W x H x D) Weight (laser with integrated VAC) Environmental conditions for transport and storage (without cooling water) Environmental conditions for operation

EMC Directive CE-marking Safety check

Diode-pumped Nd:YAG laser 1,318 nm 2 – 120 W Continuous pulse Single pulse: pulse on-time: 0.1 s – 10 s Pulse train, adjustable: pulse on-time: 0.1 s – 10 s pulse off-time: 0.1 s – 10 s 635 nm 5 mW, 2 – 100%, adjustable, pulsating Laser fibers, focusing handpiece Numerical aperture < 0.22 SMA-plus socket, mechanically coded SMA socket 2 microprocessors Rotary pushbutton and membrane keypad, 8.4” color display Compressor air cooling 230 V ± 10%; 50/60 Hz (110–230 V ± 10%; 50/60 Hz) Max. 16 A (max. 30 A) 2 x T 16 A and 2 x T 6.3 A (2 x T 30 A and 2 x T 16 A) [T = slow-blow] 3,300 W 4 I IP X1 II b 3R Neutral/no-load: 51 dB(A); full load: 60 dB(A) Integrated plug-in unit CAN bus control via Limax® 110 – 230 V ± 10%; 50/60 Hz Max. 16 A 2 x T 16 A (slow-blow) 400 W 50 x 107 x 59 cm 120 kg Ambient temperature: -15°C to +50°C (+5°F – 122°F) Relative humidity (non-condensing!): 10% to 80% Atmospheric pressure: 700 hPa to 1060 hPa Ambient temperature: +15°C to +30°C (59°F – 86°F) Relative humidity (non-condensing!): 30% to 75% Atmospheric pressure: 900 hPa to 1060 hPa 89/336/EEC In conformity with 93/42/EEC Annually

Last revised: April 2010; subject to technical modifications

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L i m a x ®: a c c e s s o r i e s

Autoclavable focusing handpiece

The fully autoclavable focusing handpiece* enables precise laser application on a non-contact basis. Ultra-high power densities guarantee optimal results when sealing, cutting or coagulating parenchymal tissue. In short, the focusing handpiece makes laser application still safer and more convenient. Perforation risks due to tissue sticking to contact fiber tips (bare fibers) are absolutely eliminated. Moreover, the autoclavability of the entire system guarantees perfect hygiene in the surgical field. No tissue adhesion – No need for intraoperative fiber preparation – Optimal hygiene

78-201-10-04

Focusing handpiece Limax®, autoclavable*

79-301-26-04

Supply fiber, 260 µm, autoclavable

79-301-40-04

Supply fiber, 400 µm, autoclavable

* Can be used only with the diode-pumped Nd:YAG laser Limax®

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Instrument for Bronchoscopy/Endotracheal Surgery ■ ■ ■ ■

Tumor ablation Stenosis removal Vaporization of pathologic tissue Hemostasis

The instrument is used in conjunction with highly efficient “bare fibers” offering outstanding beam characteristics. Working length 460 mm

Instrument for bronchoscopy/endotracheal surgery with connector for Storz optics 78-312-00-04

Ø 5.5 mm, 0° or 30° (Storz item numbers 10320 AA or 10320 BA) external diameter: Ø 8.5 mm, for Storz universal bronchoscope (Storz item number 10318 B) fiber channel diameter: 0.6 mm fits 300-µm bare fibers (79-700-30-04)

Instrument for Thoracoscopy ■ ■ ■ ■ ■ ■ ■ ■

Pulmonary vesicle ablation and thermal pleurectomies in cases of spontaneous pneumothorax Air vesicle ablation in pulmonary emphysema cases General hemostasis and fistula sealing Removal and enucleation of pleuropulmonary coin lesions (malignant and benign tumors) Partial resection of lung tissue Recurring pneumothorax Adhesiolysis Pleurodesis (various causes)

The instrument is used in conjunction with highly efficient “bare fibers” offering outstanding beam characteristics.

Working length 250 mm

Instrument for thoracoscopic surgery (complete) 78-313-00-04

with Luer-Lock connector external diameter: Ø 5 mm fiber channel diameter: Ø 1.3 mm

fits the following bare fibers 79-700-30-04

300 µm

79-700-40-04

400 µm

79-700-60-04

600 µm

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L i m a x ®: a c c e s s o r i e s

Flexible quartz fibers Maximum flexibility Extremely small spot diameters Unsurpassed power densities

■ ■ ■

Fiber preparation set ■ ■ ■ ■

79-700-30-04

Autoclavable Utmost ease of use Universally applicable Unrivaled economy

Bare fiber, 300 µm, 3 m, pack of 5 (Thoracoscopy, endotracheal surgery)

79-700-40-04

Bare fiber, 400 µm, 3 m, pack of 5 (Thoracoscopy, endobronchial surgery)

79-700-60-04

Bare fiber, 600 µm, 3 m, pack of 5 Thoracoscopy, endobronchial surgery)

79-700-41-04

Bare fiber, 400 µm, 3 m, autoclavable (Open thoracic surgery, thoracoscopy and endobronchial surgery)

79-700-61-04

Bare fiber, 600 µm, 3 m, autoclavable (Open thoracic surgery, thoracoscopy and endobronchial surgery)

Fiber preparation set, autoclavable, complete: Fiber stripper 300, 400, 600 µm 79-700-45-04

Gas-irrigated fiber, 3 m, pack of 5

Silicone mat and fiber

(for endobronchial surgery)

Knife (can be used only for bare fibers)

Fiber Holders Modular system consisting of handpiece and attachment tips (5-28 cm) for all types of interventions using the laser fiber in contact mode on the skin surface or in body cavities

Detachable tips with bending mandrel

Handpiece 78-300-10-04

Handle

78-310-05-04

5 cm

78-300-01-04

Handle spare parts set

78-310-08-04

8 cm

78-310-13-04

13 cm

78-310-18-04

18 cm

78-310-23-04

23 cm

78-310-28-04

28 cm

78-310-01-04

Tip with Luer-Lock connector

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Clinical training Education and workshops

Optimize the use of our products by taking part in our extensive training program.

In cooperation with globally recognized and experienced users, KLS Martin is regularly offering education courses with thoracoscopic topics in focus. Among those are: ■ ■

Hospitations at the sites of experienced users Dedicated laser courses acknowledged by the German medical associations On-site training by our experienced product specialists

Please ask your KLS Martin product specialist about our wide choice of education possibilities to design the right program individually for your needs.

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KLS Martin Group Karl Leibinger GmbH & Co. KG 78570 Mühlheim . Germany Tel. +49 74 63 838-0 info@klsmartin.com

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Nippon Martin K.K. Osaka 541-0046 . Japan Tel. +81 6 62 28 90 75 nippon@klsmartin.com

Gebrüder Martin GmbH & Co. KG Representative Office 121471 Moscow . Russia Tel. +7 499 792-76-19 russia@klsmartin.com

KLS Martin GmbH + Co. KG 79224 Umkirch . Germany Tel. +49 76 65 98 02-0 info@klsmartin.com

Martin Italia S.r.l. 20059 Vimercate (MB) . Italy Tel. +39 039 605 67 31 italia@klsmartin.com

KLS Martin L.P. Jacksonville, Fl 32246 . USA Tel. +1 904 641 77 46 usa@klsmartin.com

Gebrüder Martin GmbH & Co. KG Representative Office 201203 Shanghai . China Tel. +86 21 2898 6611 china@klsmartin.com

Stuckenbrock Medizintechnik GmbH 78532 Tuttlingen . Germany Tel. +49 74 61 16 58 80 verwaltung@stuckenbrock.de

Martin Nederland/Marned B.V. 1270 AG Huizen . The Netherlands Tel. +31 35 523 45 38 nederland@klsmartin.com

Rudolf Buck GmbH 78570 Mühlheim . Germany Tel. +49 74 63 99 516-30 info@klsmartin.com

KLS Martin UK Ltd. Reading RG1 3EU · United Kingdom Tel. +44 (0) 1189 000 570 info.uk@klsmartin.com

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Gebrüder Martin GmbH & Co. KG A company of the KLS Martin Group Ludwigstaler Str. 132 · 78532 Tuttlingen · Germany Postfach 60 · 78501 Tuttlingen · Germany Tel. +49 7461 706-0 · Fax +49 7461 706-193 info@klsmartin.com · www.klsmartin.com

09.11 . 90-187-02-06 . Printed in Germany · Copyright by Gebrüder Martin GmbH & Co. KG · Alle Rechte vorbehalten · Technische Änderungen vorbehalten We reserve the right to make alterations · Cambios técnicos reservados · Sous réserve de modifications techniques · Ci riserviamo il diritto di modifiche tecniche


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